MEDICARE: MS. MARY KATHERINE HALLWAY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT3850	CA

General Provider Information

NPI Number	:	1194939165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KATHERINE HALLWAY OTR

Provider Business Mailing Address
First Line	:	254 CYPRESS DR APT A
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-1742
Country	:	US
Telephone Number	:	949-887-3016
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 CYPRESS DR APT A
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-1742
Country	:	US
Telephone Number	:	949-887-3016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/10/2023

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